Yao Yuanshan, Tang Dongfang, Gao Wen, Zhang Huibiao
Shanghai Key Laboratory of Clinical Geriatric Medicine, Department of Thoracic Surgery, HuaDong Hospital Affiliated to Fudan University, Shanghai, China.
Front Surg. 2022 Apr 5;9:843987. doi: 10.3389/fsurg.2022.843987. eCollection 2022.
Stage III Non-small cell lung cancer (NSCLC) is a heterogenous disease with novel treatment options. Recently, immunotherapy has attracted a lot of attention for advanced NSCLC.
The objective of our study was to assess the efficacy and safety of neoadjuvant immuno-chemotherapy for resectable stage III NSCLC.
We analyzed 11 stage III primary NSCLC surgical cases who had undergone standard lobectomy or bronchial sleeve resection and lymph node dissection between December 2020 and July 2021. The data analyzed included basic clinical features, serum levels of key biomarkers, clinical efficacy in the perioperative period, postoperative pathological results, postoperative complications and the incidence rates of Immune-Related Adverse Events.
Eleven patients were enrolled in our study with a mean age of 67.7 ± 4.8 years, and 10 patients being men with former or current smoking history. Squamous carcinoma (10/11, 91.1%) was the most common cancer type. Six patients had stage IIIa, five had stage IIIb. All patients received two or three cycles of neoadjuvant immuno-chemotherapy, with the median duration between the last treatment and surgery being 39 days (range, 32-46 days). All patients underwent R0 resection with ten patients undergoing single-port video-assisted thoracoscopic surgery. The median operative time was 170 min (range, 120-240 min). Only three (3/11, 27.3%) patients experienced mild postoperative complications and the mean hospital stay time was 6.9 days (range, 4-15 days). Nine (9/11, 81.8%) patients experienced major pathological response of which seven (7/11, 63.6%) was complete pathological response in postoperative results. The pathological stage was downgraded in 10 (10/11, 91.1%) patients, and although the incidence of Immune-Related Adverse Events was slightly higher (8/11, 72.7%), most events were grade 1-2 and did not delay surgery.
Our study demonstrated that neoadjuvant immuno-chemotherapy is feasible and relatively safe for resectable stage III primary NSCLC patients. We hope this new neoadjuvant immuno-chemotherapy model can improve overall survival and open a new era for stage III primary NSCLC patients.
Ⅲ期非小细胞肺癌（NSCLC）是一种具有多种新型治疗方案的异质性疾病。近年来，免疫疗法在晚期NSCLC治疗中备受关注。
本研究旨在评估新辅助免疫化疗用于可切除Ⅲ期NSCLC的疗效和安全性。
我们分析了2020年12月至2021年7月期间接受标准肺叶切除术或支气管袖状切除术及淋巴结清扫术的11例Ⅲ期原发性NSCLC手术病例。分析的数据包括基本临床特征、关键生物标志物的血清水平、围手术期临床疗效、术后病理结果、术后并发症及免疫相关不良事件的发生率。
11例患者纳入本研究，平均年龄67.7±4.8岁，10例为男性，有既往或当前吸烟史。鳞癌（10/11，91.1%）是最常见的癌症类型。6例为Ⅲa期，5例为Ⅲb期。所有患者接受了两或三个周期的新辅助免疫化疗，最后一次治疗与手术之间的中位间隔时间为39天（范围32 - 46天）。所有患者均实现R0切除，10例患者接受单孔电视辅助胸腔镜手术。中位手术时间为170分钟（范围120 - 240分钟）。仅3例（3/11，27.3%）患者出现轻度术后并发症，平均住院时间为6.9天（范围4 - 15天）。9例（9/11，81.8%）患者出现主要病理反应，其中7例（7/11，63.6%）术后为完全病理反应。10例（10/11，91.1%）患者病理分期降低，尽管免疫相关不良事件的发生率略高（8/11，72.7%），但大多数事件为1 - 2级，未延迟手术。
我们的研究表明，新辅助免疫化疗对于可切除的Ⅲ期原发性NSCLC患者是可行且相对安全的。我们希望这种新的新辅助免疫化疗模式能够提高总生存期，为Ⅲ期原发性NSCLC患者开启一个新时代。
